J Trauma
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Multicenter Study Comparative Study
Hemodynamic reactions in patients with hemorrhagic shock from blunt trauma after initial fluid therapy.
This study sought to define hemorrhagic shock from blood pressure and heart rate and then to provide a treatment policy based on response to initial fluid therapy. ⋯ Patients whose first SI was ≥ 0.8 and second SI ≥ 1.0 would be diagnosed as "nonresponders" by American College of Surgeons. Patients with first SI < 0.8 and base deficits ≥ -1.0 will not be candidates for the B group.
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Multicenter Study Comparative Study
Emergency medical services transport decisions in posttraumatic circulatory arrest: are national practices congruent?
To catalog the 9-1-1 emergency medical services (EMS) transport practices for posttraumatic circulatory arrest patients (PTCAPs) in the majority of the nation's largest municipalities and to compare those practices to guidelines recommended by the National Association of EMS Physicians (NAEMSP) and American College of Surgeons Committee on Trauma (ACSCOT). ⋯ Many of the nation's highest volume EMS systems transport certain PTCAPs emergently, contrary to NAEMSP-ACSCOT guidelines to terminate resuscitative efforts in such cases. Reasons for these discrepancies should be evaluated to help better delineate applicable consensus guidelines for large urban EMS agencies.
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To assess the depressant effects of alcohol on the level of consciousness of patients admitted with head injuries, this study examined the changes that occur in the Glasgow Coma Scale (GCS) of traumatic brain injury patients over time. ⋯ This study concludes that the GCS increases significantly over time in alcohol intoxicated patients with traumatic brain injury.
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Occurrence on weekends or at night has been associated with poor outcomes for time-sensitive conditions including ST elevation myocardial infarction, stroke, and cardiac arrest. We sought to determine whether the "weekend effect" exists for injured patients at our trauma center. ⋯ Differential mortality on off-hours is not seen at our Level I trauma center. Outcomes that are independent of time of day and day of week may be because of the explicit requirements for trauma centers to be fully staffed and operational at all times. There are implications for staffing and systems solutions for other time-sensitive disease including ST elevation myocardial infarction, stroke, and cardiac arrest. Interventions may include the development of a categorization system based on emergency care capabilities, development of explicit staffing requirements, and requiring an emergency care-specific quality improvement program.
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Comparative Study
Hips can lie: impact of excluding isolated hip fractures on external benchmarking of trauma center performance.
Trauma centers (TCs) vary in the inclusion of patients with isolated hip fractures (IHFs) in their registries. This inconsistent case ascertainment may have significant implications on the assessment of TC performance and external benchmarking efforts. ⋯ Given the fact that IHFs in the elderly significantly influence risk-adjusted outcomes and are variably reported by TCs, these patients should be excluded from subsequent benchmarking efforts.